Spinal Cord Syndromes Myelopathy

Question 1

Myelopathy?

Answer 1

Any disease that affects the spinal cord

Question 2

If a patient points where in back should you be concerned?

Answer 2

Thoracic cord

Question 3

Damage to corticospinal tract result in?

Answer 3

Hyper-reflexia, spasticity, + Babinskis sign, weakness

Question 4

Damage to posterior column result in?

Answer 4

Loss of vibration, position sense, and + Romberg Sign

Question 5

Damage to spinothalamic tract result in?

Answer 5

Loss of pain and temperature, sensory level

Question 6

Damage to anterior horn cells result in?

Answer 6

Flaccid weakness, hypo-reflexia, fasciculation

Question 7

Damage to root result in?

Answer 7

Lancinating pain, numbness, hypo-reflexia

Question 8

Where is dermatome for T4 located? T10?

Answer 8

Nipple line

Umbilicus

Question 9

Acute central lesions cause what type of bladder dysfunction?

Answer 9

Flaccid, acontractile (atonic) bladder with continued reflex contraction of urethral sphincter. Urinary retention, bladder distention, and overflow incontinence

Question 10

Chronic central lesions cause what type of bladder dysfunction?

Answer 10

Hyperreflexic (spastic) bladder. Urinary frequency and urge incontinence caused by detrusor-sphincter dyssynergia

Question 11

Acute and sub-acute myelopathies are what?

Answer 11

NEUROLOGIC EMERGANCIES

Question 12

Early (A) in the progression of epidural lesions of the spinal cord?

Answer 12

Motor symptoms (compression of corticospinal tract) hyperreflexia, +Babinski's sign, difficulty walking
Sensory - root irritation, hypersensitive to touch, band or girdle-like sensation in abdomen
Urinary urgency

Question 13

The second (B) progression of epidural lesions of the spinal cord?

Answer 13

Motor - Legs are spastic and week, brisk reflexes, babinsky sign still present
Sensory - root are is totally numb (IPSILATERAL), Pain in CONTRALATERAL LE is decreased (spinothalamic)
Partial Brown-Sequard
Definite sphincter dysfunction

Question 14

The final (C) progression of epidural lesions of the spinal cord?

Answer 14

Motor - Flaccid, arflexic due to spinal cord shock or spastic papaparesis if more chronic/subacute
Sensory - Complete sensory level to all modalities at level of the lesion

Question 15

Disc disease where can cause epidural cord compression and myelopathy?

Answer 15

Cervical or thoracic

Question 16

Most common cancers that lead to epidural myelopathy?

Answer 16

Lung, breast, prostate

Question 17

Where does most metastatic cancer begin?

Answer 17

vertebral body

Question 18

Where does most spinal abscesses begin?

Answer 18

Disc space

Question 19

The common infection of the spinal cord?

Answer 19

S. Aureus

Question 20

Pott’s disease?

Answer 20

Neurologic syndrome of osteomyelitis resulting from TB infection

Question 21

If you see dumbbell shape on MRI what do you think?

Answer 21

Schwannoma/neurofibroma

Question 22

Early (A) progression of a central cord lesion?

Answer 22

Pain in shoulders (cervical lesion), Loss of pain/temperature, crossing spinothalamic tracts are involved early

Question 23

(B) progression of a central cord lesion?

Answer 23

Reflexes are lost in arms (lesion involves root entry zones), Loss of pain/temperature is severe (pt my burn himself), Horner’s syndrome, Touch and position are intact, legs develop spastic paraparesis, + Babinski signs and hyperreflexia due to corticospinal damage.

Question 24

(C) progression of a central cord lesion?

Answer 24

Sacral Sparing, may involve the face due to the sensory nucelus of the trigeminal nerve

Question 25

Anterior 2/3 of the spinal cord is supplied by?

Answer 25

Artery of Adamkiewicz (Great radicular artery)

Question 26

Anterior spinal artery syndrome?

Answer 26

Spinothalamic and corticospinal dysfunction with intact posterior column function

Question 27

Brown-sequard hemi-section syndrome?

Answer 27

Rare - stab wound, some myelitis
Ipsilateral spastic paralysis below the level of the lesion
Hyper-reflexia, + Babinski signs
Ipsilateral loss of vibration and joint position sense
Contralateral loss of pain/temp